Nursing diagnoses for patients with AML

Five nursing diagnoses for patients with AML:

1. Acute pain related to physical agents (bone marrow packed with leukemic cells) and/or chemical agents (antileukemic treatments) as evidenced by reports of pain

2. Risk for infection related to inadequate secondary defenses, including alterations in mature white blood cells, increased number if immature lymphocytes, and bone marrow suppression

3. Activity intolerance related to generalized weakness; reduced energy stores, or effect of drug therapy as evidenced by external discomfort or dyspnea

4. Risk for bleeding related to reduced platelet counts and suppression of bone marrow

5. Risk for fluid volume deficit related to fluid intake and output or excessive loss (vomiting, bleeding, diarrhea)

Nursing  Diagnosis	Actual or Potential	Related to	Plan and outcome	Nursing intervention
Risk for fluid volume deficit	Potential	Excessive loss and decrease in fluid intake	- Adequate fluid volume for body weight - Mucosa moist - Vital signs stable - UOP 30 ml/hr - Cap refill <2 seconds	- Monitor intake and output, body weight, vital signs. - Evaluation of skin turgor, cap refill and mucous membrane conditions

http://nurseslabs.com/5-leukemia-nursing-care-plans/

http://nursing-care-plan.blogspot.com/2011/12/2-nanda-nursing-diagnosis-and.html

Nursing care for AML patients

Nursing care:	Rationale:	Outcome:
Monitor vital signs	To collect baseline	Nurse will have the resources to identify changes from baseline, and monitor for signs and symptoms of infection
Inspect skin and mucous membranes for petechiae, bleeding gums, frank or occult blood in stool or urine.  Monitor for bruising.	Suppression of bone marrow and platelet production puts patient at risk for bleeding.	Nurse will be able to notice signs and symptoms of bleeding early on in order to manage early intervention
Implement measures to prevent tissue injury or bleeding	Patients with leukemia have fragile tissues and altered clotting mechanisms, which can increase risk of hemorrhage	Nurse will avoid sharp objects, minimize invasive procedures, etc. in order to minimize risk of bleeding or tissue injury
Monitor mucous membranes and signs and symptoms of mucositis.	When receiving chemotherapy, patients who are immunocompromised are at risk for mucositis as they are often affected by severe tissue disruption and pain.	Nurse will be able to notice signs and symptoms of mucositis in order to manage pain early on and implement measures to help with pain.
Provide thorough skin care by keeping patient’s skin and perineal area clean; apply mild lotion or creams to keep the skin from drying or cracking. Thoroughly clean skin before all invasive procedures.	Immunocompromised patients are at a high risk of infection.	By keeping skin from being dry and cracking, this protects their first line of defense against pathogens. These are more measures to eliminate opportunities for infection.
Encourage increased intake of foods high in protein and fluids with adequate fiber.	Promotes healing and dehydration. Constipation can potentiate retention of toxins and risk of rectal irritation or tissue injury.	Patient remains properly hydrated and able to maintain regular bowel function.
Monitor for pain and nausea, and treat accordingly	Nausea is a common side effect of treatment, and pain is common with cancer.	Patient should remain as comfortable as possible, and minimize effects of nausea and pain.

http://www.scribd.com/doc/62062942/Nursing-Care-Plan-AML#scribd

http://nurseslabs.com/5-leukemia-nursing-care-plans/

Treatment and progression of AML

Like many kinds of cancers, the prognosis and treatment options for acute myeloid leukemia depend on many different factors. Including the AML subtype, treatment response, and risk stratification. There are also different factors like your white blood cell count, your age, and your overall health that will have an impact on which treatment option may be the right one for you.

Since there are so many different combinations of contributing factors to one specific patient, we will discuss the two main types of treatment for AML: Chemotherapy, and Bone Marrow Transplants.

Chemotherapy

There are a number of chemotherapy regimens that have shown to be effective against AML. The goal of chemotherapy treatment is to kill the malignant cells without damaging the residual bone marrow cells. 

Clinical studies are constantly underway to discover the best regimens, doses, and treatment schedules for AML.

Bone Marrow Transplants

There are three different kinds of bone marrow transplants:

Allogeneic bone marrow transplants use stem cells from a donor, and are the most common type of transplants used for this disease. Most of the time, the donor’s genes must match some of your own, and be a good “match” for you. This kind of donor can be related, by blood, or unrelated, from a stranger whose genes match yours enough to be fit for a transplant.

            

Umbilical cord blood transplant is a type of allogeneic transplant, where cells are removed from a newborn baby’s umbilical cord, and are then frozen and stored for a recipient who needs it.

Autologous bone marrow transplants use stem cells that were removed from your own body, before receiving high-dose chemotherapy or radiation treatment. Your own stem cells are stored in a freezer and kept aside, this is called cryopreservation.

http://www.seattlecca.org/diseases/adult-acute-myeloid-leukemia-treatment.cfm

http://www.nlm.nih.gov/medlineplus/ency/article/003009.htm